Imaging investigation after urinary tract infection in childhood: narrative review of current recommendations

A. C. Simões e Silva, L. Jabour, B. Vieira, E. A. Oliveira
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Abstract

Background and Objective: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. The imaging exams that take place after the occurrence of UTI have the main goal of detecting congenital anomalies of the kidney and urinary tract (CAKUT). The value of imaging investigation relies on guiding the management of the patient and directing measures to prevent recurrent infections and to avoid possible kidney scars. Currently, there has been a general trend to restrict the number of imaging tests performed in clinical practice as can be seen in the most important guidelines regarding the management of patients with febrile UTI. The guidelines from the American Association of Pediatrics (AAP), the National Institute for Health and Care Excellence (NICE), and the European Association of Urology (EAU)/European Society for All Pediatric Urology (ESPU) made recommendations in this regard. We believe that the critical discussion about the advantages and disadvantages of the different guidelines and protocols proposed is important for pediatricians and nephrologists and helps to define the best approach for patients. In this matter, this review aimed to provide a critical view of imaging investigation methods and guidelines after UTIs in pediatric patients. Methods: The authors performed a non-systematic search in PubMed, Cochrane, Scopus, SciELO and in renowned books from the subjects of pediatric nephrology and pediatric urology published up to August 5th, 2021, and critically selected and independently reviewed articles written mainly in English or Portuguese to produce this narrative review. Key Content and Findings: In this narrative review, shortcomings of different imaging guidelines and examinations after urinary tract infections in children are explored, while the principles and advantages of distinct imaging methods are highlighted. We find that, while an initial renal and bladder ultrasonography is of great value, more invasive exams need to be carefully selected to identify patients at risk for further complications whilst minimizing distress and other consequences to the child. Conclusions: A renal ultrasonography with good quality of images and examined by an expert is generally recommended as initial screening after UTI. Additional imaging exams depend on findings provided by renal ultrasonography. but the exam is of low
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儿童尿路感染后的影像学调查:目前建议的叙述性综述
背景与目的:尿路感染是儿童最常见的细菌感染之一。在尿路感染发生后进行的影像学检查的主要目的是检测肾脏和尿路的先天性异常(CAKUT)。影像学检查的价值在于指导患者的管理,指导预防复发感染和避免可能的肾瘢痕的措施。目前,总的趋势是限制临床实践中进行的影像学检查的次数,这可以从有关发热性尿路感染患者管理的最重要指南中看出。美国儿科协会(AAP)、国家健康与护理卓越研究所(NICE)和欧洲泌尿外科协会(EAU)/欧洲儿科泌尿外科学会(ESPU)的指南在这方面提出了建议。我们认为,对不同指南和方案的优缺点进行批判性讨论对儿科医生和肾病学家很重要,并有助于为患者确定最佳方法。在这方面,本综述旨在为儿科患者uti后的影像学检查方法和指南提供批判性的观点。方法:作者在PubMed、Cochrane、Scopus、SciELO以及截至2021年8月5日出版的儿科肾脏病学和儿科泌尿学领域的知名书籍中进行了非系统检索,并严格选择和独立审查了主要以英语或葡萄牙语撰写的文章,以产生这一叙述性综述。主要内容和发现:本文综述了儿童尿路感染后不同成像指南和检查方法的不足,并强调了不同成像方法的原理和优势。我们发现,虽然最初的肾脏和膀胱超声检查很有价值,但需要仔细选择更多的侵入性检查,以确定有进一步并发症风险的患者,同时尽量减少对儿童的痛苦和其他后果。结论:尿路感染后,一般建议进行高质量的肾脏超声检查,并由专家检查。其他影像学检查取决于肾脏超声检查的结果。但是考试很低
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